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Wednesday, September 14, 2016
Addiction, stigma, treatment and recovery
Twenty-three million people in the United States struggle with substance use disorders. The prevalence of these disorders and their wide-ranging effects has made them the number one public health concern in the country—unintentional overdose is the leading cause of accidental death, and according to the National Institute on Drug Abuse, the annual economic cost is $700 billion from lost productivity, health care spending and criminal justice involvement.
In response to this epidemic, thousands of treatment options have become available, from dedicated treatment facilities to recovery support groups and more. But despite the massive impact of addiction on communities nationwide and the wide availability treatment options, only about 10% of individuals with substance use disorders actually receive some form of help. This disparity all too often results from the stigma that surrounds addiction, which poses a major barrier to entering treatment for many people, according to John F. Kelly, PhD, director of the Massachusetts General Hospital’s Recovery Research Institute and associate director of the Center for Addiction Medicine.
In a recent presentation on “Addiction, Stigma, Treatment, Recovery” given as part of Mass General’s Recovery Month events, Dr. Kelly explained, “Addiction is treatable, and most people recover.”
A key step in that recovery for many individuals, however, is overcoming the cultural stigma around addiction.
Stigma and Recovery
One important element in the formation of this stigma is the language we use to describe addiction. This has been a primary focus of Dr. Kelly’s research: “Language affects people’s perceptions, even when they’re not aware of it,” he said. Addiction can be framed and perceived very differently depending on the vocabulary chosen--certain language suggests an individual’s willful misconduct, while other word choices present addiction as a health issue faced by the individual.
One study conducted by Dr. Kelly, "Does it matter how we refer to individuals with substance-related conditions? A randomized study of two commonly used terms," examined these differences in language use and perception among highly trained mental health professionals. The study divided participants into two groups, and each was given a description of an individual with an addiction at risk for relapse. In one case the individual was described as “a substance abuser,” while in the other he or she was described as “a person with a substance use disorder.”
The group that received the description with “substance abuser” perceived the individual as more to blame, more in need of punishment and less in need of treatment. The study serves as a powerful reminder that these cultural stigmas can have a significant impact, even among highly trained professionals.
Moving Toward Change
Research like this has prompted further discussion about the language used to talk about addiction, both culturally and in the medical setting. “We’ve been pushing now to change our language and how we refer to individuals with these conditions in describing them,” Dr. Kelly said. “[We’re] moving away from 'abuse' and 'abuser,' and moving toward person-first language (i.e. 'a person with a substance use disorder')."
Words have power to influence the way we understand the world. If we can change the way we talk about addiction, perhaps we can begin to reduce the stigma surrounding it and treat addiction like the chronic disease it is, Dr. Kelly said.
With less stigma, the hope is that these problems can be caught earlier. And that matters—Dr. Kelly reminded the audience: “The earlier we catch it and intervene...the shorter the time to remission. Just like cancer, the earlier you catch it, the better the prognosis.”
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